Cardiologia (Rome, Italy)
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Cardiologia (Rome, Italy) · Oct 1998
Review Case Reports[Recurrent ventricular fibrillation in acute myocardial infarct treated successfully by coronary angioplasty: a clinical case in favor of the hypothesis of the arrhythmogenicity of the coronary thrombus?].
We describe a patient with acute myocardial infarction due to thrombotic occlusion of the left anterior descending coronary artery. Following thrombolytic therapy, five episodes of ventricular fibrillation recurred despite the absence of profibrillatory factors other than myocardial ischemia. ⋯ After successful mechanical artery recanalization, no recurrences of the malignant arrhythmia were observed. This case supports the concept, recently demonstrated in animals, that the process of intracoronary thrombosis itself may have arrhythmogenic effects above and beyond the impact of myocardial ischemia induced by coronary occlusion per se.
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Cardiologia (Rome, Italy) · Oct 1998
[Idiopathic atrial fibrillation of recent onset and atrial stunning: the echocardiographic evidence after pharmacological cardioversion].
Successful cardioversion of atrial fibrillation may result in prolonged recovery of normal atrial mechanical function. This prolonged recovery of atrial contraction (so-called atrial stunning) might depend on: the amount of energy delivered during direct current cardioversion; the time course between the onset of atrial fibrillation and the conversion to sinus rhythm; the size of the left atrium; the underlying cardiac disease. The aim of this study was to evaluate, in subjects with normal atrial size and without heart disease, the phenomenon of atrial stunning soon after pharmacological cardioversion of an episode of atrial fibrillation of recent onset. ⋯ In contrast, both peak A velocity (cm/s) and E/A ratio evaluated within 12 hours of cardioversion (60.29 +/- 12.3 and 1.0 +/- 0.37) and on day 3 (73.71 +/- 10.7 and 0.82 +/- 0.27) were statistically different (p < 0.000001 and p < 0.00001). No further statistically significant increase was found in subsequent examinations (respectively 76.31 +/- 12 and 0.78 +/- 0.24 on day 12, and 76.91 +/- 14.8 and 0.78 +/- 0.21 on day 30). In conclusion, this study suggests that patients with alone atrial fibrillation of recent onset have a delayed recovery of normal atrial systolic function even after pharmacological cardioversion.